Hypos & IOB

[Topher]

Hi all, if after 2 hours your bs are about 4.3 and going low, and let's say you have about 2 units of IOB, would you eat carbs to match your IOB?

 

[CarbsRok]

No as would need over 50 carbs on that ratio. If heading hypo I would treat with minimum carbs and sit it out.

 

[donnellysdogs]

I would eat 3 sugar cubes and wait it out. It's not just IOB to take in to account for me though... It's whether I have sat down for the night or whether I am still active or the heat or stress etc.... I always do the minimum and watch before just jumping in and risking a higher level....

 

[Topher]

Ok thanks I'll try the same

 

[iHs]

If the bg is lower than ideal 2hrs after the bolus and there's a large IOB of 2u left to run for another 2hrs, then I would eat some carb sufficient to use up the IOB or hypoland I go if I just ignore it. If it was 3hrs after the bolus, then I would just eat a short acting carb like jellybabies to use up IOB as they only affect bg for about 1hr. A lot of pump stuff is trial and error and you learn what works for you as you go along. Hope you are ok..

 

[noblehead]

I'd definitely eat some carbs with a bg level of 4.3mmol with 2 units of IOB.

 

[Spiker]

Yes in this "negative IOB" situation (where IOB plus BG predicts a hypo) I do eat carbs to exactly match the IOB. I am not sure why anyone would do different than that? Surely if you take anything less than carbs = IOB you would expect a hypo to follow?

By the way I am surprised that pumps and meters don't generate a warning or alarm when they detect a "negative IOB" situation. They should be actively telling you that you need to eat X amount of carbs - unless you already have.

 

[noblehead]

By the way I am surprised that pumps and meters don't generate a warning or alarm when they detect a "negative IOB" situation. They should be actively telling you that you need to eat X amount of carbs - unless you already have.

Good point @Spiker.

 

[Engineer88]

Yes in this "negative IOB" situation (where IOB plus BG predicts a hypo) I do eat carbs to exactly match the IOB. I am not sure why anyone would do different than that? Surely if you take anything less than carbs = IOB you would expect a hypo to follow?

By the way I am surprised that pumps and meters don't generate a warning or alarm when they detect a "negative IOB" situation. They should be actively telling you that you need to eat X amount of carbs - unless you already have.

One thing I find is that IOB can still be there to cover undigested foods - I try not to go overboard on treating the hypo as its usually insulin in there for a reason

 

[noblehead]

One thing I find is that IOB can still be there to cover undigested foods - I try not to go overboard on treating the hypo as its usually insulin in there for a reason

Again a good point @Engineer88, certainly true if you've previously eaten a high-fat meal.

 

[Spiker]

Yeah but. As long as you measured carbs properly and tested properly and dosed properly, if you test again later and current BG minus IOB predicts a hypo then you have a risk. Of course there may be errors in the IOB function. I am cautious in taking extra insulin when IOB seems insufficent to correct current BG. But undigested food? Not so sure about that. Maybe. I need to think about that more.

 

[Engineer88]

Yeah but. As long as you measured carbs properly and tested properly and dosed properly, if you test again later and current BG minus IOB predicts a hypo then you have a risk. Of course there may be errors in the IOB function. I am cautious in taking extra insulin when IOB seems insufficent to correct current BG. But undigested food? Not so sure about that. Maybe. I need to think about that more.

It's something I come up against all the time. Happened Sunday in fact. Sunday dinner (potatoes parsnips stuffing veg and chicken followed by homemade cheesecake) about hour and a half later I was 4 did I eat no, I watched it rise and by bedtime it was 12 (when I corrected a bit)

 

[dtennant9]

I think it all goes to show what a balancing act it can be at times. When you are low after two hours all factors need to be looked at before acting.

 

[Spiker]

It's something I come up against all the time. Happened Sunday in fact. Sunday dinner (potatoes parsnips stuffing veg and chicken followed by homemade cheesecake) about hour and a half later I was 4 did I eat no, I watched it rise and by bedtime it was 12 (when I corrected a bit)

Definitely agree some food is slow acting and can take you low. But insulin acts more uniformly and predictably than food does. What was your IOB showing when your BG was 4?

In your case what was needed was more insulin actually rather than more carbs. So yes that demonstrates this is very hard to get right.

 

[Engineer88]

Definitely agree some food is slow acting and can take you low. But insulin acts more uniformly and predictably than food does. What was your IOB showing when your BG was 4?

In your case what was needed was more insulin actually rather than more carbs. So yes that demonstrates this is very hard to get right.

Disagree. I had used a 40/60 combo bolus - if I had a higher dose of insulin I would have hypoed for sure. Can't remember iob and I didn't know exact carbs either.

 

[Spiker]

If you ended up at 12 then you did need more insulin surely?

It sounds like the solution would have been a larger but more extended bolus. In hindsight. I wasnt considering the situation where a combo bolus is still running. But your scenario definitely makes the point that it is not always wise to take carbs when IOB predicts a hypo.

 

[donnellysdogs]

Multiwaves are not always the best way.... As again its not exact and when carbs aren't exact either it can throw up all sorts of scenarios.

Still say if you were low 11/2hrs after bolus then it wasn't your bolus but your basal...